{"data":{"id":"us-ky/krs-205.5363","jurisdiction":"us-ky","citation":"KRS 205.5363","heading":"Nonemergency medical transportation services -- Annual report.","body":"(1) The provision of nonemergency medical transportation services to eligible\nMedicaid enrolled beneficiaries in the Commonwealth shall comply with 42 U.S.C.\nsec. 1396a(a)(87), 42 C.F.R. sec. 431.53, 42 C.F.R. sec. 440.170, any other relevant\nfederal law or regulation, and this section, except that this section shall not apply to\nany nonemergency medical transportation services, including transportation via\nstretcher, covered by a Medicaid managed care organization.\n(2) A nonemergency medical transportation service program administered under this\nsection and relevant federal law shall:\n(a) Be administered under a regional brokerage delivery model;\n(b) 1. Utilize a capitated payment model.\n2. Capitation payments made to regional brokers shall be:\na. Actuarially sound;\nb. Set by an actuary contracted by the Department for Medicaid\nServices;\nc. Calculated based only on the number of nonemergency medical\ntransportation service eligible Medicaid enrollees, as determined\nby the Department for Medicaid Services in accordance with KRS\n205.513(2)(c), within a given region and shall not be based on the\ntotal number of Medicaid enrollees; and\nd. Calculated separately for each region with consideration given to\neach region's average trip time, average trip distance or average\nmileage per trip, and other region -specific factors, including but\nnot limited to geography, terrain, and population density; and\n(c) Require regional brokers to:\n1. Achieve an annual medical loss ratio for each state fiscal year as\nrequired under subsection (3) of this section;\n2. Provide a remittance to the state of any excess capita tion payments for\nany state fiscal year in which the regional broker fails to achieve an\nannual medical loss ratio as required under subsection (3) of this\nsection;\n3. a. Ensure that all vehicles used to provide Medicaid -covered\nnonemergency medical transportation services are equipped with a\nglobal positioning system device that enables the broker to\ndetermine the precise location of the vehicle at all times when the\nvehicle is being operated to provide nonemergency medical\ntransportation services.\nb. Any cost that may be associated with the requirement to equip\nvehicles used to provide Medicaid-covered nonemergency medical\ntransportation services with a global positioning system device\nshall be borne by the regional broker and not the Department for\nMedicaid Services or any other state agency; and\n4. Collaborate with the Department for Medicaid Services, or another\nagency in state government or a private entity with which the\ndepartment has contracted for the administration of a nonemergency\nmedical transpo rtation service program, to implement and execute a\nperformance-based payment model that aligns incentives for Medicaid\nenrollees, drivers, regional brokers, and the Commonwealth to improve\nquality, reliability, and cost -effectiveness in the nonemergency m edical\ntransportation service program. The performance -based payment model\nrequired under this subparagraph shall include a two percent (2%)\nwithhold from each regional broker's capitation amount that can be\nearned back in full or in part by the regional t ransportation broker\nthrough achievement of designated performance -based measures which\nshall:\na. Be developed in a manner that reflects the unique circumstances of\neach region; and\nb. Include but not be limited to:\ni. Utilization rates;\nii. The number of nonemergency medical transportation service\ntrips completed;\niii. The number of nonemergency medical transportation service\ntrips canceled or rescheduled;\niv. The number of delayed nonemergency medical\ntransportation service trips;\nv. Average trip time;\nvi. Average miles per trip;\nvii. The amount of time required to schedule a nonemergency\nmedical transportation service; and\nviii. Rider satisfaction.\n(3) (a) For the state fiscal year beginning July 1, 2026, regional brokers shall be\nrequired to achieve a medical loss ratio of at least eighty-five percent (85%).\n(b) For the state fiscal year beginning July 1, 2027, regional brokers shall be\nrequired to achieve a medical loss ratio of at least eighty-seven percent (87%).\n(c) For the state fiscal year beginning  July 1, 2028, regional brokers shall be\nrequired to achieve a medical loss ratio of at least eighty-nine percent (89%).\n(d) For the state fiscal year beginning July 1, 2029, and each state fiscal year\nthereafter, regional brokers shall be required to achi eve a medical loss ratio of\nat least ninety percent (90%).\n(4) Utilization rates for nonemergency medical transportation services, including when\ncalculated by an actuary under subsection (2) of this section, shall consider only\nnonemergency medical transp ortation service eligible Medicaid enrollees, as\ndetermined by the Department for Medicaid Services in accordance with KRS\n205.513(2)(c), within a given region and shall not be based on the total number of\nMedicaid enrollees.\n(5) (a) A skilled nursing facility or hospital shall be permitted to provide\nnonemergency medical transportation services for residents of the skilled\nnursing facility or patients of the hospital if the transportation service would\nbe considered a Medicaid -covered service if provided by a driver contracted\nby a nonemergency medical transportation service regional broker.\n(b) A skilled nursing facility or hospital that provides nonemergency medical\ntransportation services under this subsection shall be eligible for\nreimbursement by the locally contracted nonemergency medical\ntransportation service regional broker at the same mileage rate as would be\npaid to a driver contracted by the regional broker for the same service.\n(c) This subsection shall not establish or imp ose upon a skilled nursing facility or\nhospital any duty or responsibility to provide nonemergency transportation\nservices to an individual who is not a resident of the facility or patient of the\nhospital.\n(6) When submitting data or reports to the Departm ent for Medicaid Services or any\nother agency of state government with responsibility for oversight or administration\nof the nonemergency medical transportation services, the chief executive officer,\nchief financial officer, president, executive director, or another officer of a regional\nbroker shall attest, to the best of his or her knowledge, to the truthfulness, accuracy,\nand completeness of all data or reports at the time of submission.\n(7) Beginning in 2027, the Department for Medicaid Services shall c onduct an annual\nreview of the nonemergency medical transportation service program and submit a\nreport to the Legislative Research Commission for referral to the Interim Joint\nCommittees on Health Services and Appropriations and Revenue and the Medicaid\nOversight and Advisory Board by July 1 of each year. The review and report\nrequired by this subsection shall, at a minimum, include information and\nrecommendations for the following:\n(a) Utilization rates;\n(b) The number of nonemergency medical transportation service trips completed;\n(c) The number of nonemergency medical transportation service trips cancelled\nor rescheduled, including the reason for cancellation or rescheduling;\n(d) The number of delayed nonemergency medical transportation service trips;\n(e) Average trip time;\n(f) Average miles per trip;\n(g) The amount of time required to schedule a nonemergency medical\ntransportation service;\n(h) Rider satisfaction; and\n(i) The performance-based payment model required under subsection (2) of this\nsection.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57034","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"7d146dd78eb9a34ef8438b7ec4aa9da7297e503abce13597a552ada3ffa4bb42","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.5361","next":"us-ky/krs-205.5365"},"notice":"GroundRules: Original legal text. Not legal advice."}